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The Journal of Cardiovascular Surgery 1998 June;39(3):343-9

language: English

The impor­tance of repeat­ed ­risk assess­ment for pres­sure ­sores in car­di­o­vas­cu­lar sur­gery

Stordeur S., Laurent S.*, D'Hoore W.**

From the Department of Cardiovascular Surgery and *Department of Internal Medicine Cliniques Universitaires Saint-Luc, Brussels, Belgium
**Centre for Hospital Sciences Ecole de Santé Publique Université Catholique de Louvain, Brussels, Belgium


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Background. Patients under­go­ing car­di­o­vas­cu­lar sur­gery are at ­high ­risk for ­sores ­because of ­impaired per­fu­sion, the ­time ­spent on the oper­at­ing ­room ­table, and restrict­ed mobil­ity in the imme­di­ate post­op­er­a­tive peri­od.
Objective. To iden­ti­fy ­risk fac­tors for ­sores.
Methods. In a 900-bed teach­ing hos­pi­tal, 163 ­patients who under­went car­di­o­vas­cu­lar inter­ven­tions ­were ­enrolled. Risk meas­ure­ment includ­ed ­skin assess­ment, Braden and Norton ­scales, phys­ic and bio­log­ic ­data and spe­cif­ic ­risk fac­tors. The devel­op­ment of the ­most ­severe stag­es of pres­sure ­sores was fol­lowed (Stages II and III).
Results. Forty-­eight (29.5%) ­patients total­ized 75 pres­sure ­sores. In uni­var­i­ate anal­y­ses, Norton and Braden ­scores, hemo­glo­bin con­cen­tra­tion, pres­ence of ­ulcers at admis­sion, use of anti­hy­per­ten­sive ­drugs, system­ic use of cor­ti­cos­ter­oids, nos­o­co­mi­al infec­tion, re-inter­ven­tion and read­mis­sion in inten­sive ­care ­units ­were asso­ciat­ed ­with ­sores. In a logis­tic regres­sion mod­el, hemo­glo­bin con­cen­tra­tion at admis­sion (p=0.0007), post­op­er­a­tive Braden ­score (p=0.0002), and post­op­er­a­tive ster­oid ther­a­py (p=0.020) ­were the ­only pre­dic­tors of ­sores. Total ­length of ­stay was 6 ­days high­er (p=0.03) for ­patients ­with pres­sure ­sores.
Conclusions. The detec­tion of ­risks is rec­om­mend­ed dur­ing the ­entire ­stay. Identification of ­patients at ­risk is ­required to pro­vide pre­ven­tive resourc­es appro­pri­ate­ly, ­which can less­en the inci­dence of pres­sure ­sores and ­reduce ­patient dis­com­fort, ­length and ­costs of hos­pi­tal ­stay.

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